Provider Demographics
NPI:1679943625
Name:CHRISTENSON, AMANDA (BSW)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:
Last Name:CHRISTENSON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1581
Mailing Address - Country:US
Mailing Address - Phone:248-321-7617
Mailing Address - Fax:248-443-2845
Practice Address - Street 1:321 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-1581
Practice Address - Country:US
Practice Address - Phone:248-321-7617
Practice Address - Fax:248-443-2845
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-03
Last Update Date:2015-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI$$$$$$$$$OtherSOCIAL SECURITY NUMBER